1023172236 NPI number — MERIDIAN TRAUMA ASSOCIATES, P.C.

Table of content: (NPI 1023172236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023172236 NPI number — MERIDIAN TRAUMA ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERIDIAN TRAUMA ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023172236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416754
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-6754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-807-0800
Provider Business Mailing Address Fax Number:
732-922-0805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 STATE ROUTE 33
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-776-4949
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLARKE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
732-765-6317

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)